Harvard experts say state map is flawed

 A screen shot of the West Virginia Department of Education’s website shows the state’s newly tweaked metrics map introducing an orange category, which had covered counties with 10.0 to 24.9 positive cases per 100,000 residents, split into two new categories: gold, covering those counties with 10 to 14.9 cases per 100,000, and orange, 15 to 24.9 per 100,000. Being in the gold allows students in those counties to attend in-person school. This is the Sept. 12 map. 

https://mountainstatespotlight.org/2020/09/18/the-governor-tweaked-a-harvard-covid-map-their-experts-say-the-states-changes-are-flawed/

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In August, Gov. Jim Justice introduced West Virginia’s parents, teachers and coaches to a new Saturday night ritual: refreshing a state website for updates to the color-coded map that would determine whether ballfields and schoolhouses would be open the following week.

State officials modeled the map after one developed by the Harvard Global Health Institute, which places counties into one of four risk levels — green, yellow, orange or red — based on the number of Covid-19 cases per capita.

The map developed by West Virginia’s Department of Health and Human Resources looks similar to the Harvard map, lending a veneer of academic rigor to the state’s school reopening plans.

But they are never the same. West Virginia officials have relied on outdated data, raised the cutoff that determines each county’s risk level and altered the methodology for determining the total number of cases.

The pandemic has become more deadly as West Virginia leaders have downplayed the risks. In recent months, West Virginia’s death toll has risen faster and faster, hitting a record in August of 98 deaths. The state now has had one of the highest Covid “reproductive rates” – the number of people an infected person will spread the disease to, on average – in the nation.

Members of the Harvard team that developed the metric said West Virginia was misusing their work.

“That doesn’t follow the public health guidance,” said Dr. Thomas Tsai, a health policy researcher and surgeon at Harvard.

“It’s like they’re saying you have five downs now, instead of four,” he added, borrowing an analogy from football.

Tsai said the goal of the Harvard team, made up of ethicists, policy researchers and public health experts, was to create a single, clear metric that could be used by cities and counties across the country to assess the extent of their coronavirus outbreak.

“Everybody was talking about reopening using different terminology, different levels of color coding, and it was one of our goals to develop a consensus,” he said.

But that scientific consensus proved incompatible with the desires of West Virginia leaders, who wanted to get athletes back onto the field and students back into school as quickly as possible. For weeks, the most obvious similarity between the two maps has been the color palette, and even that disappeared when Justice alchemized five orange counties into “gold” on Tuesday.

Dr. Clay Marsh, the executive dean of West Virginia University’s medical school and the state’s coronavirus czar, has justified the changes by arguing that Harvard’s metric “had never been validated on small states.”

“Ultimately, this is a decision that our state’s leadership made in how they modify this,” Marsh said in an interview earlier this week.

The governor’s office did not respond to a request for comment. But in public statements, the governor has characterized the repeated changes as improvements. “Just because we had a good plan doesn’t mean we can’t make it better,” Justice said in a press conference on Tuesday.

Tsai disagreed that the metric should be altered, or that it somehow did not apply to West Virginia.

“The point is to have a common definition and transparency on the metrics. You can’t be accountable if you keep changing it,” he said.

Tsai offered another analogy to drive the point home, imagining Justice justifying the installation of a radically redesigned stoplight. “We used red, yellow and green – but we made green red and red green,” he said.

“Is that inspired by a traffic light?” he said. “No.”

On Aug. 14, Justice announced the “School Alert System” as a way to determine where it was safe to bring students back into the classroom. Counties that were green and yellow would be able to offer in-person instruction. Counties that were orange and red – where the metric determined there was a high risk of community spread of the virus – would be virtual only.

During the announcement, Marsh explained the map’s origins.

“We’re really going off of the Harvard Global Health Institute model, and this is a model that’s really generated by public health experts,” he said.

But the fundamental differences between the Harvard and West Virginia metric were immediately obvious. On Justice’s map, the state was largely green. On Harvard’s, it was awash in orange and yellow.

West Virginia leaders had raised the cutoffs determining the point at which counties had enough cases to qualify them for more risky colors. Counties were green (minimal community transmission) with up to 7 cases per 100,000 residents and yellow (increasing transmission) up to 15. In Harvard’s metric, the cutoffs were 1 and 10, respectively.

After the metric was announced, Kanawha County Commissioner Ben Salango, a Democrat who is challenging Justice in the upcoming gubernatorial election, held a press conference to accuse the governor of “fudging the numbers” and “distorting reality.”

By that afternoon, following Justice’s own press conference in which he attacked the media’s “saber rattling” as “ridiculous,” the state’s map had been changed to a hue closer to the Harvard metric. The cutoffs for red and orange were synced with Harvard.

But there were still significant differences. Throughout August, the case numbers in Fayette County reported by the state’s Department of Health and Human Resources had lagged behind the numbers published by Harvard and The New York Times.

By the end of the month, West Virginia was reporting a seven-day moving average of just over 10 cases per 100,000 residents. Fayette County was now in the orange – but just barely.

According to Harvard, the county had moved deep into the red and had nearly five times more cases than the numbers reported by West Virginia.

The reason: the Mount Olive Correctional Complex. The state prison in Fayette County had reported an outbreak. Nearly 14 percent of the prison’s inmates came down with the virus.

But prisoners and nursing home residents are not included in the West Virginia metric – and until Aug. 17, staff members at those institutions had been counted only as “half” a case – “because these individuals are not in the community,” according to a press release from DHHR.

Tsai found this argument unconvincing. The state should “absolutely” be including prisons in its metric, he said.

“It’ll be better if you reacted to it because you’re counting it and seeing it,” Tsai said. “Two weeks if it’s better, then let's reopen the schools. Or we discount the data and reopen schools and it turns out the linen supply company that delivers to the prison also happens to deliver to the school basketball team.”

Several days after the outbreak was reported at the prison, Fayette County’s health director, Dr. Anita Stewart, reported “a major upswing of community transmission” in the county and called it “very perplexing and concerning.”

“There’s an obvious direct correlation to the numbers inside the prison, whether it’s inmates or staff – and the community spread,” said Lida Shepherd, a program director at the American Friends Service Committee, a nonprofit that advocates for criminal justice reform.

She said the state’s policy “does not comport with the public health consensus about the impact of an outbreak in prisons.”

The state has not only tweaked who gets counted, but when.

Now, state officials use outdated data when they publish the finalized risk levels on Saturdays, used to determine whether schools can reopen the following week.

In late August, that map included data from Friday, according to analysis by Mountain State Spotlight of data published on the DHHR’s Covid dashboard.

Now, that has changed. When the DHHR announced the updated map on Saturday, it was based on data from midnight on Thursday.

The DHHR publishes updated case and death totals every day.

Marsh, the coronavirus czar, said that the state stopped using Friday data because there wasn’t time to verify it by Saturday.

The changes have caused mass confusion among teachers, who are told they are going back to school even when the metric says they shouldn’t have to.

“We’re not listening to science,” said Jennifer Craig, a special education teacher in Wheeling and president of the Ohio County Education Association. “We’re seeing school buildings filled with children and staff and high rates of community transmission because of the changing metrics.”

Officials have not just changed the metrics. Sometimes they ignore them.

The state has a Covid-19 Data Review Panel, which includes Marsh and the state’s top public health officials. The panel reviews case numbers and has the final say on each county’s risk designation.

Last week, the panel downgraded Monroe County from red to orange – despite the county remaining above the 25 cases per 100,000 cutoff – because the panel “concluded the level of COVID-19 transmission in Monroe County was improving.”

And Calhoun County remained in the yellow, with its schools open last week, despite having enough cases to qualify as orange.

Marsh said that the panel reviewed case reports from the county and determined the outbreak was confined to an “extended group of people” who were immediately quarantined.

“We’re not trying to actually change what the data is … we’re trying to make sure the data is accurate and trying to make sure the data is accurately assessed,” said Marsh.

These inconsistencies have angered parents in counties that weren’t deemed worthy of an exception, like Monongalia, where an influx of WVU students triggered a massive outbreak.

“There is a lot of bias and flaws in the chart,” said Terrie Turney, a Morgantown resident with two children attending Monongalia County schools.

She anxiously awaits the updated map for news that her kids can safely return to the classroom. As of Thursday evening, the county was orange. Kanawha had been upgraded to red.

“There is no consistency, there’s no stability with it whatsoever,” Turney said.

She’s become frustrated as theaters reopen and WVU students return to campus, yet schools remain closed. She and dozens of other Morgantown parents have organized rallies to protest what they see as unfairness.

Earlier this month, Alex McLaughlin, a Kanawha County parent, filed suit against the governor, seeking to stop enforcement of school closings in orange and red counties.

McLaughlin argued that the state’s metric wasn’t based on science. “To date, (state officials) have not disclosed any scientific data, opinions, or analyses that actually or affirmatively support their discrimination against schools,” McLaughlin wrote in a legal filing on Monday.

If the goal is to reduce the spread of the virus, McLaughlin said the state should order everyone to stay home – not just students.

Harvard accompanies its metric with policy recommendations, which, if the state followed them, would force some counties to shut down. According to Harvard’s metric, “stay-at-home” orders are “advised” at orange and “necessary” at red.

On Tuesday, Justice announced yet another change to the map. He added another category — gold, a color chosen by Justice — that effectively lifted restrictions on five of the eight red and orange counties. Effective immediately, those counties would be allowed to hold in-person classes.

The next day, Justice announced that nearly 80 infected students – now quarantined – on WVU’s campus would be treated as a single case. He said that change “moves us more toward the finish line” and that prior reported numbers may have been “somewhat skewed.”

These decisions followed a highly publicized four-hour “emergency” meeting on Monday between Justice and his public health advisers — “all the experts from all the different fields,” said the governor.

Their counsel did not, apparently, sway Justice.

“I had made my mind up way, way, way before I ever got down here yesterday,” he said on Tuesday.

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